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General NPI Number Information
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NPI Number | 1902864689
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Entity Type | Organization
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Legal Business Name | OGE FAMILY MEDICAL CLINIC
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Dates
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Enumeration Date | 05/03/2006
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Last Update Date | 06/06/2012
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Provider Practice Location Address
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Address Line | 410 N MAIN ST SUITE 2
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City | NASHVILLE
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State | AR
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Zip | 71852-2006
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Country | US
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Telephone | 870-451-9199
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Fax | 870-451-9442
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Provider Business Mailing Address
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Address Line | PO BOX 905
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City | NASHVILLE
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State | AR
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Zip | 71852-0905
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Country | US
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Telephone | 870-451-9199
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Fax | 870-451-9442
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Authorized Official
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Title or Position | OWNER
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Name | BRIAN T OGE
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Credential | M.D.
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Telephone | 870-451-9199
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | E3925
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License Number State | AR
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